IXGPR Order Form

Please type in the following information, then FAX form with 
credit card number or mail form via post with payment:

REGISTRATION NAME : __________________________________________
                      (name must be at least 11 characters)
Registration Name MUST BE the name of the individual or company named below

Full Name : __________________________________________________
                   (first, middle initial & last)
Address: 
	   _____________________________________________________

	   _____________________________________________________
       
	   _____________________________________________________

	   _____________________________________________________

Country:   _____________________________________________________

E-mail address:   ______________________________________________

[Telephone (with Area Code)]:     ________________________________

Version you are using: v (e.g. 1.00)	 ___•______

IXGPR license/password:                   US$   499

If your connection is not fast enough to download the shareware, order the CD:

IXGPR CD-ROM sent by Postal Mail:         US$    49
IXGPR CD-ROM sent by Courier (USA):       US$    75
IXGPR CD-ROM sent by Courier (foreign):   US$    99

Total Payment Due:                        US$ __________

Payment by:
	[ ] Check/money order enclosed (payable to Interpex Limited)
	[ ] VISA / MasterCard (charged in US currency)
		PLEASE FAX LEGIBLE COPY OF FRONT & REAR OF CREDIT CARD!!
		VISA / MasterCard number:

		 ________ ________  ________  ________	Expires:    ___/___

	Cardholder name: ________________________________  3-Digit Authorization

	Signature:                                         Code: ____________
		   ______________________________________  (from back of card)

[Comments/Suggestions]:  _____________________________________________________

______________________________________________________________________________

Please FAX or mail this form to the address below.  You will be sent a code that  
unlocks the software when used with the user name shown above. 

	Interpex Limited		FAX: (303) 278-4007
	P.O. Box 839			www.interpex.com
	Golden, CO 80401-0839
	USA